Heart artery calcium scan coverage

A. A group health care plan, other than a small group health care plan, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible subscribers to receive a heart artery calcium scan. B. Coverage provided pursuant to this section shall: (1) be limited to the provision of a heart artery calcium scan to an eligible subscriber to be used as a clinical management tool; (2) be provided every five years if an eligible subscriber has previously received a heart artery calcium score of zero; and (3) not be required for future heart artery calcium scans if an eligible subscriber receives a heart artery calcium score greater than zero. C. At its discretion or as required by law, a health care plan may offer or refuse coverage for further cardiac testing or procedures for eligible subscribers based upon the results of a heart artery calcium scan. D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified- disease policies, plans or certificates of health insurance. E. As used in this section: (1) "eligible subscriber" means a subscriber who: (a) is a person between the ages of forty-five and sixty-five; and (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence- based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation; (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and (3) "heart artery calcium scan" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function. History: Laws 2020, ch. 79, § 5.